Out of danger, prognosis good

LIKE all the best medical practitioners, the new CEO of Bass Coast Health, Jan Child, imparts a sense of calm and control even in the midst of crisis.

When she arrived in April as acting CEO, Bass Coast Health was a virtual cot case, facing a $3.5 million deficit, with dilapidated facilities and declining services. After the sudden resignation of both the CEO and the chairman of the board in April, Ms Child was co-opted by the Department of Health from Peninsula Health, where she was chief operating officer and director of nursing and allied health.

She was happy to come. “I love the area. I almost applied for the position some time ago. I thought I could make a difference here.”

On Thursday, the BCH board appointed her to the permanent position following a recruitment process which attracted a large number of candidates. Now she is talking not about problems but about opportunities.

When she arrived, BCH was headed for a $3.5 million deficit for 2015-16; by the end of the financial year she had reined that in to a $750,000 deficit, taking it out of crisis mode. Remarkably she didn’t do it by cutting services, rather the reverse.

“The focus before I came had been to cut, cut, cut,” she explains. “We had become paralysed by the financials. I walked into the hospital and saw all these empty beds. The best way to run a hospital is to run it like a business. We changed strategy. We need bums in beds. So we’ve chased revenue in the past four months.”

When she started, the hospital was transferring about 50 per cent of patients to other hospitals instead of treating them. The state benchmark is 75 per cent. If we can get near that mark, we’ll be well on our way, she says.

Apart from the loss of revenue from transferring patients, it cost around $10,000 per person for each helicopter transfer to the city, which was happening two or three times a week. She convinced the Department of Health that BCH needed some recompense for the costs. She also set out to reduce the numbers of patients being transferred unnecessarily.

Her plan for retaining more patients is to build infrastructure, equipment and staff capability, and bring in expertise as required through various means. “We’ve partnered with Peninsula Health in cardiology, with Monash in obstetrics and with Barwon Health for strokes. We can ring their specialists 24 hours a day and describe the symptoms and they’ll advise what the patient needs.” Frankston Hospital’s cardiology specialists will also come and run education sessions for BCH doctors and nurses.

“We’ve got to create really easy pathways for our community to get help. We should be doing more complex surgery, more complex medicine. Cardiac arrest and stroke patients should be a dime a dozen.

For instance, she says, if the hospital could get an ultrasound machine, it would stop 10 transfers a week of heart patients. “They are easy tests, diagnosis is very easy. It only costs $120,000 and would pay for itself in a year. But we don’t have a spare $120,000.” She is hoping the community will come to the party by raising funds to get one.

Listening to Jan Child talk, I find myself swept up in the magic of the numbers. Everything she says makes so much sense on a human as well as an economic rationalist basis.

With enough imagination, a combination of problems created unexpected solutions. One of the first things she did was to transfer the sub-acute (rehabilitation) beds out of the medical ward and put them in Armitage House, a nursing home attached to the hospital with only a few residents left. The move meant more sub-acute beds and more medical beds. It also meant the few remaining residents of Armitage could remain in their home.

At Griffiths Point aged care facility in San Remo, she replaced personal care workers with nurses which meant not just better care for the residents but also lower costs for BCH because there were fewer ambulance callouts.

Then there was Wonthaggi’s emergency department. It’s one of the best in the state’s rural hospitals, she says, with highly skilled staff. But she discovered it wasn’t being paid properly for the services it provided. Why not? “Because we hadn’t asked for it.”

She wants to increase allied health home visits, to develop a high dependency unit to care for patients after surgery, to work with Latrobe Regional Hospital to offer chemotherapy at Wonthaggi Hospital, as it already does at Leongatha.

“My vision is for us to become a sub-regional hospital in five years. I don’t think it’s going to be that hard. It’s just a matter of taking the steps to build capability and revenue. It’s important to grow in a measured way. Every time you notch up another one you’re a step closer.”

She’s also looking at alternative treatment options to free up beds and raise revenue.“If you walked through the hospital, you would find out of 40 beds there would be 10 people we could care for at home through the Hospital in the Home program.

“We will have funds in our budget this year to invest in it. You need good nurses. We can recruit more staff – the right doctor mix, training up our nurses with specialist skills.”They are recruiting for several key positions. “We have nursing staff and doctors who have been doing the same work for many years. We haven’t skilled them up, we haven’t got new equipment, we haven’t changed the way we practise medicine.

“If you get your staff right the patient care will follow. Staff who used to work at the hospital are returning. They want to know they’re not going to be deskilled and that we’ll invest in them.”

Then there are all those ageing medical specialists with holiday homes at Cape Paterson, Inverloch or Phillip Island. “What a resource!” she says. “What better than to bring their expertise to a hospital five minutes from home?” She is in talks with a cardiologist about working at the hospital a couple of days a week.

She’s also met several times with the Phillip Island health and medical action group pressing for a new hospital on Phillip Island to replace Warley Hospital.

“There is this glow about Warley but it was struggling and a clinical risk. I’ve been to several of their meetings and said I don’t think it needs a hospital, it needs a good emergency service and a good ambulance service.”

She says the new Phillip Island medical hub, scheduled to open in Cowes late next year, will offer a range of specialist services, as well as Hospital in the Home and telemedicine, reducing the need for patients to travel.

In May, the state government gave Bass Coast Health $30,000 to draw up a clinical services plan. Instead BCH asked for $160,000 for a regional clinical services plan to cover Wonthaggi, Leongatha, Korumburra, Foster and Latrobe hospitals.

“We need to identify who does what because we can’t all do everything. At the moment Leongatha does what we do – were almost competing for patients.”

The plan will be finalised by November and give BCH a road map for the next 10 years – including, she hopes, a plan of the steps required to gain sub-regional status for Wonthaggi hospital.

As she shows me to the exit, she’s still talking enthusiastically about her plans. She indicates a dilapidated old clinical services building. That’s where she envisages the new emergency department, right at the entrance, close to the car park, so sick people don’t have to struggle up the stairs and along the corridors.

She’s applied to the Rural and Regional Infrastructure Fund for $10 million to make the move. She laughs. “We probably won’t get it, but at least they’ll know were serious.”

COMMENTS​​August 14, 2016Congratulations on a very insightful article on Bass Coast Health. As a retired member of the community the most negative feedback I get from fellow retirees is the poor state of health services in our region and the need to return to Melbourne if one is very unwell. Turn left at the round-a-bout is oft quoted if one is requiring attention for one’s health. Therefore it was heartening to read the new CEO of BCH is positive about future initiatives and making plans to move Wonthaggi Hospital to a sub-regional hospital. I would also like to commend the reporter, it was great to read an article that was positive and included thoughtful analysis. Well done, such a change from the local newspaper.Lorrie Read, Rhyll

It is heartening to read such a positive article especially about our hospital. Everything I hear about Jan Childs is good and she will make a wonderful addition to our Bass Coast Community. I applaud the Department for their work on this one also. We pushed hard in the last State election for Sub Regional status for the hospital and it seems it is on the radar. I am always an advocate for asking for the funds and demonstrating the competence to manage it. And you can put the Bass Coast Pickers down to help with raising funds toward the Ultra Sound machine - lets put on a a well supported concert or two!Michael Whelan, Cowes

BASS Coast Health’s acting CEO has welcomed funding for a clinical services plan which she says is a crucial first step in upgrading Wonthaggi Hospital to a sub-regional facility.​State Health Minister Jill Hennessy announced the $30,000 funding at the hospital yesterday.

Ms Hennessy toured the hospital and spoke to medical, nursing and senior administrative staff about problems and opportunities for local services. She also visited the Bass Coast Health service hub at San Remo (“the most picturesque view from any health facility in Australia”).

Bass Coast Health Jan Child said a clinical services plan would enable Bass Coast to build capacity and augment it with services from other providers where necessary.

“It’s a building block to let us know what services we need to provide, not just in the next few years but in 10 years’ time. It enables us to plan our workforce and our facilities.“The next step is refreshing our master plan, particularly for Wonthaggi Hospital, but also for the services we need to provide in Cowes, San Remo and Inverloch.”

Ms Child said Bass Coast Health would never be in a position to provide all services, such as an intensive care unit, but it could eventually provide many more services than it currently does.

However, one of the problems Bass Coast Health faces is the number of local patients bypassing services at the hospital and travelling to the city for treatment, meaning that many of these services are under-utilised and therefore not cost-effective to provide. “We do have a few more people going up the highway rather than coming here first,” Ms Child told the minister. “Partly that’s about providing more services and that’s what the clinical services plan will allow us to do.

“We know the road map is for Wonthaggi to become a sub-regional hospital. This plan will help us get there.”

A 2010 master plan for the Wonthaggi Hospital made the case for a $200 million upgrade of the hospital to sub-regional status. It envisaged increasing the existing 54 acute beds to 100 beds, redeveloping the existing 60 residential aged care places and upgrading and increasing support services and infrastructure. However, there has been little progress since the plan was released under the previous Labor Government

Ms Hennessy, who also visited Latrobe and West Gippsland hospitals this week, said all the hospitals were doing terrific things. “It’s about getting all those services integrated.”

Bass Coast Health has been operating in deficit for several years. The board was rocked last month by the resignation of the CEO, Veronica Jamison, and chairman, Peter Laydon.

Ms Child was seconded from Peninsula Health as acting CEO and Don Paproth took over as acting chairman of the board last week. The board has also interviewed three potential new board members and recommended their appointment to the minister.

Mr Paproth, who studied and taught at Wonthaggi Secondary College, also took the opportunity to put in a plug for local tertiary students. “Our students can only catch a bus to Dandenong. They can’t catch a bus to Federation University [in the Latrobe Valley and Warragul]. They would have to drive to get to Federation.”

Double blow for Bass Coast Health

THE CEO of Bass Coast Health has left, just days after the board chairman Peter Laydon announced his resignation.

Veronica Jamison, who had had been CEO for about 16 months, left on Wednesday, eight months before the end of her two-year contract.

An acting CEO, Jan Child, has been seconded from Peninsula Health and will take up the post on Monday.

Mr Laydon announced two weeks ago that he would step down as chairman because he was finding the demands of the voluntary position too onerous.

He was elected chairman of the board last June, replacing long-term chairman Jeff Bennett.Mr Laydon has agreed to stay on for another month to help ease Ms Child into her role.

Don Paproth will then become acting chairman of the board until new elections are held in June. The board’s acting chair, Christine Hammond, declined to take on the role for personal reasons.

Bass Coast Health has been operating in deficit for several years, with a $3.1 million loss in 2014-15.

The Department of Health declined to answer questions from the Post, referring all questions to Mr Laydon, who praised Ms Jamison as “a tireless worker who put in very long hours”.

He said the CEO informed him last week of her decision not to seek a renewal of her contract. “It’s not unusual to be given an option of leaving straight away. It gives us time to employ a new CEO.”

He said the board and CEO operated under a fair amount of financial pressure but had taken steps to turn around the deficit. “In the last six months we’ve done some good work. Hopefully when Jan comes in she can take up where Veronica left off.”

Mr Laydon said that while most health services around the state struggled with finances, there were additional pressures on rural and regional health services such as Bass Coast.“We’ve got to have the personnel available but we don’t have the volume of patients to pay for them. The cost of providing services outweighs the income we can get from them.

“Each time we transfer someone to Melbourne, that costs us $10,000. There’s not much we can do about that. It’s just a difficult situation for us.”

He was critical of the Federal Government’s recent decision to cut health funding. “If you listen to the federal politicians, increasing GST is all about putting the extra resources into health and education. Yet the Federal Government has just taken in excess of $1 billion out of the health system.

“For Bass Coast Health, that translates to $220,000 removed from our funding next year. On one hand, they’re saying we need more money; on the other, they’re taking it away.”